目的:目的是评估(i)理论实施的质量,(ii)行为改变技术的应用,和(iii)基于理论的干预措施在促进孕妇体育锻炼和改善孕产妇和新生儿结局方面的有效性。
方法:在8个数据库中进行了系统搜索(护理和相关健康文献的累积指数,Cochrane图书馆,EMBASE,MEDLINE,APAPsycINFO,PubMed,SPORTDiscus,和WebofScience),以确定从数据库开始到2023年7月8日发表的随机对照试验。使用Cochrane偏倚风险2.0工具评估纳入研究的质量。理论编码方案用于衡量理论实现的质量,和行为改变技术是根据行为改变分类法(版本1)编码的。使用RevMan5.3进行荟萃分析。建议的分级,评估,发展,采用评估方法对证据的确定性进行评估。
结果:11项研究符合研究标准。九项研究基于一种理论,而两项研究是基于两种理论的结合。理论实施的质量总体上是中等的。总共提取了24种独特的行为改变技术。最常用的行为改变技术类型是“关于如何执行行为的指令”(n=9),“目标设定”(行为)(n=8),“行动计划”(n=7),和“关于健康后果的信息”(n=7)。基于理论的干预措施显着改善了中等至剧烈的身体活动(标准化平均差(SMD)=0.17,95%置信区间(CI)[0.04,0.30],P=0.01;证据的中等确定性),降低了每周平均妊娠体重增加(平均差(MD)=-0.06,95%CI[-0.11,-0.01],P=0.02;证据的中等确定性),并降低妊娠期糖尿病的发病率(风险比(RR)=0.64,95%CI[0.46,0.89],P=0.008;证据的高确定性)。然而,基于理论的干预措施对总身体活动的影响,妊娠期总增重、妊娠期高血压和早产发生率不明确(P>0.05)。
结论:(i)大多数研究表现出中等水平的理论实施质量。(二)理论的运用各不相同,但是在研究中发现了常见的行为改变技术。(iii)基于理论的干预措施可以改善身体活动以及产妇和新生儿的结局,并且似乎是安全的。在未来的干预措施中应充分利用适当的健康行为理论和行为改变技术。
背景:PROSPERO:CRD42023440886。
结论:基于理论的干预措施可以改善体力活动和母婴结局,而且看起来是安全的。在未来干预措施的发展中应充分利用适当的健康行为理论和行为改变技术。
OBJECTIVE: The objectives were to assess (i) the quality of theory implementation, (ii) the application of behavior change techniques, and (iii) the effectiveness of theory-based interventions in promoting physical activity in pregnant women and improving maternal and neonatal outcomes.
METHODS: A systematic search was conducted across 8 databases (Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, EMBASE, MEDLINE, APA PsycINFO, PubMed, SPORTDiscus, and Web of Science) to identify randomized controlled trials published from database inception to 8 July 2023. The Cochrane risk-of-bias 2.0 tool was used to evaluate the quality of the included studies. The theory coding scheme was used to measure the quality of theory implementation, and behavior change techniques were coded according to behavior change taxonomy (version 1). The meta-analysis was performed using RevMan 5.3. The Grading of Recommendations, Assessment, Development, and Evaluation Approach was used to assess the certainty of evidence.
RESULTS: Eleven studies met the study criteria. Nine studies were based on one theory, while two studies were based on a combination of two theories. The quality of theory implementation was generally moderate. A total of 24 unique behavior change techniques were extracted. The most commonly used types of behavior change techniques were \'instruction on how to perform the behavior\' (n = 9), \'goal setting\' (behavior) (n = 8), \'action planning\' (n = 7), and \'information about health consequences\' (n = 7). Theory-based interventions significantly improved moderate-to-vigorous physical activity (standardized mean difference (SMD) = 0.17, 95 % confidence interval (CI) [0.04, 0.30], P = 0.01; moderate certainty of evidence), reduced the average gestational weight gain per week (mean difference (MD) = -0.06, 95 % CI [-0.11, -0.01], P = 0.02; moderate certainty of evidence), and decreased the incidence of gestational diabetes mellitus (risk ratio (RR) = 0.64, 95 % CI [0.46, 0.89], P = 0.008; high certainty of evidence). However, the effects of theory-based interventions on total physical activity, total gestational weight gain and the incidence of gestational hypertension and preterm delivery were unclear (P > 0.05).
CONCLUSIONS: (i) Most of the studies exhibited a moderate level of theory implementation quality. (ii) The use of theories varies, but common behavior change techniques were found across studies. (iii) Theory-based interventions can improve physical activity and maternal and neonatal outcomes and appear to be safe. Appropriate health behavior theories and behavior change techniques should be fully utilized in future interventions.
BACKGROUND: PROSPERO: CRD42023440886.
CONCLUSIONS: Theory-based interventions can improve physical activity and maternal and neonatal outcomes and appear to be safe. Appropriate health behavior theories and behavior change techniques should be fully utilized in the development of future interventions.